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Sunday, March 25, 2012

According to Cottone and Claus (2000), the integration of the intuitive factor into ethical decision making "improves the decision-making process" (para. 13). Hill, Glaser, and Harden (1995) believe "values, beliefs, and factors such as gender, race, class and sexual/affectional preferences of the people involved are assumed to affect the ethical dilemma (para. 17).

According to Cottone and Claus (2000), the integration of the intuitive factor into ethical decision making "improves the decision-making process" (para. 13). Hill, Glaser, and Harden (1995) believe "values, beliefs, and factors such as gender, race, class and sexual/affectional preferences of the people involved are assumed to affect the ethical dilemma (para. 17).

The pros of this model is that it uses the therapist's intuition as part of the decision making.As it is with any human decision, the use of intuition creates a limitation, in that the decision may only be as ethically strong as the decision maker's intuition.The second strength is that it is a more holistic model for ethical decision making in that it accounts for a wider range of human factors in the process.The second limitation could be that this model gives more power to the client.In some cases, and depending on the client's value systems, it could inhibit the counselor's most appropriate choice in the decision.

The first step is to gather information to determine the nature of the ethical problems.Then the stake holders must be identified as well as the primary client.Finally, the counselor identifies applicable standards, such as codes and laws (Hill, Glaser, and Harden, 1995).If there is a standard that applies to the problem, the solution is in applying that standard to the problem.If there is not one particular code or law that is obviously applicable, one must work toward identifying the primary ethical principle (if two or more principles are competing.)If the counselor still has no idea how to decide, he or she must "consult with others, research the literature, and attempt to prioritize the principles" (Hill, Glaser, & Harden, 1995, p. 23).Ultimately the choice is toward reaching a balancing between doing the least harm and achieving the best and most successful outcome.Finally, the counselor must determine if the choice causes other ethical dilemmas and if it is practical to implement.After implementing the decision, it should be reviewed and evaluated.

The bottom line in ethical decision making is that merely embracing ethical models only provides a parameter by which individuals understand, in a rhetorical sense, how to best utilize these models.The most positive outcomes, however, must implement and integrate these models into an intrinsic and core understanding.As new counselors are exposed to the various gray areas of ethical decision making, it is essential not only to understand ethics, but to be ethical.As Rest (1994, as cited in Cottone & Claus, 2000) believed, these models are neither linear aspects nor temporal orders, but must be visceral understandings.From deep understanding comes our ability to make decisions that can be supported by any one of the models of decision making.Ultimately, we cannot make moral judgments yet remain indifferent.There must be a deep and evolving commitment to becoming ethical.

The code that resonated with me most was in the American Counseling Association's (ACA) (2010)Code of Ethics.I appreciated the depth to which the ACA described and defined the level of teaching and the supervisory role for new mental health counselors.The issue of adequate supervision was evident in Pressures From All Sides: A Rehabilitation Counselor's Dilemma, in the ACA handbook (Herlihy & Corey, 2006) wherein the supervisor encouraged the supervisee to regard the company that was being represented by the counselors, rather than keep the client as the primary interest.

Section F.1.a. Client Welfare in the ACA (2010) code defines and describes the "rules of engagement" between supervisors and supervisees.It clearly states that supervisors must always adhere to the ACA Code of Ethics.Not only in supervisory practice, but in the basic definitions afforded by both codes of ethics, we must do no harm and always function in the best interest of the client.Regarding and honoring the needs of others (whether individuals or group entities) before the needs of the client is clearly unethical.By placing the needs of others before those of the client, the counselor is not applying ethical principles of working in the client's best interest, but also may be creating potentially harmful circumstances for the client.

When the supervising counselor told the supervisee to regard the interests of the insurance company, he was disregarding the primary interest of the client as well as dishonestly encouraging business with another business entity, in essence, working in their favor to receive additional business. Additionally, the supervisor's recommendations added further conflict to an already difficult situation for Kate (the new counselor.)

Additionally, the AMHCA Code of Ethics (2010) Section III Commitment to Students, Supervisees and Employee Relationships, states, "the primary obligation of supervisors is to monitor services provided by supervisees to ensure client welfare" (p. 14).The supervisor did not seem to be representing the best interests of Kate's client (Herlihy & Corey, 2006).

The importance of Section F.3.a (ACA, 2005) and supervisory roles was evident in The Case of the Well-Meaning Feminist (Herlihy & Corey, 2006). There is evidence that Allison's supervisor hasn't provided enough training in multicultural competence.Allison has imposed her personal needs and expectations on her clients (Herlihy & Corey, 2006).Although I, like Allison, would have a natural tendency to create a stronger sense of autonomy in her client, although with a better understanding of the client's cultural context, and a more articulate perspective of my own expectations, I would have counseled otherwise.

I believe the supervisory role is pivotal in a new counselor's development.In both the above cases, better training and recommendations made by the supervisors would have led to more positive outcomes for the new counselors as well as the clients.Supervisors should be held to higher ethical standards than other mental health counselors.Their supervision is foundational in our seminal experience as a counselor.

Justice and beneficence are two foundational issues in counseling ethics and legal issues.Although these two are mandatory components of ethical functioning at any level, they must be self-evident for counselors, and certainly essential and fundamental in practice (Herlihy & Corey, 2006).

Herlihy and Corey (2006) define justice as "our commitment to fairness" (p. 9) that includes several issues involved within counseling practice such as the counselors personal ethics, fees structures, and the implementation of appropriate fairness in the counseling relationship.Forester-Miller and Davis (1996) claim justice does not mean the same treatment for all clients, but when differences exist, there must be reasonable rationale for the difference in treatment, and it must be appropriate within the counselor/client relationship and appropriate and in the client's best interest.

Justice in best practices must take into account the client's current and past cultural environment, and especially when it is different from the counselor's.Fairness includes respecting clients' cultural values and refraining from the imposition of one's personal beliefs when those beliefs are inappropriate.For example, when counseling an individual whose beliefs are based on a collectivist culture, encouraging the client to take a prominent position or to create a distinct social persona would be an affront to his or her family and society.Such counsel would likely not be in the client's best interest.

Beneficence is "promoting good, (or) mental health and wellness" (Herlihy & Corey, 2006, p. 9).Forester-Miller & Davis (1996) include a description of responsibility in counselor behavior as well as developing an ability to navigate the counselor/client relationship "proactively" (para. 3). This includes always counseling in the best interest of the client, not according to personal beliefs.

Beneficence, in best practice, demands counselors maintain an awareness of the client's unique circumstances.The continuing demographic changes in this country presents an opportunity to understand and gain competence in various cultural differences to promote appropriate mental health and wellness effectively (Remley & Herlihy, 2001).Certainly human behavior cannot be adequately judged, or for that matter, changed, without considering the cultural context within which the behavior takes place (Solomon, Greenberg, & Pyszczynski, 1991).

It would not be culturally competent to counsel an 18-year-old male entrenched in an inner city drug culture to get an education to get ahead in the world.Although we can promote forward change in clients, we have to embrace reasonable expectations and a realistic plan according to the full scope of the client's circumstances (Remley & Herlihy, 2001).In best practices, counselors must consider the foundational contexts, cultural and otherwise, to work within the boundaries of the client's best interest. In any event, the challenging nature of ethical decision making necessitates reliance on the foundational ethical values embraced by the profession (Jennings, Sovereign, Bottorff, Mussell & Vye, 2005).

The strengths of an Adlerian approach for Abby are the encouragement she will receive and the trusting, caring relationship she will build with her therapist.The limitations of this approach have to do with her immediate needs; specifically her acute depressive symptoms and her inability to function in her daily routines.She may need psychopharmacological therapy and possibly short-term inpatient therapy.From a diversity perspective, if Abby's African American culture supports her need for her therapist to function as an expert and provider of solutions, Adlerian therapy may not be the best choice.Additionally, the amount of family and personal information that needs to be collected may be excessive for Abby during her acute symptoms (Corey, 2009).

Cultural/Gender/Age Issues

Abby is a 57-year-old African American female.If the therapist is not African American, consideration must be given to Abby's thoughts, preferences, and ability to develop a close client/therapist relationship with someone culturally different (Corey, 2009).The therapist must be culturally competent and able to identify with her unique circumstances.Because of her difficulty with her husband's medical diagnosis, sensitivity to the effects of cancer among family members is critical.If the therapist is considerably younger than Abby, he or she must understand Abby's developmental stage and her experience as a mature woman.

Ethical and Legal Issues

The gravity of Abby's situation must be assessed immediately.If the therapist has reason to believe Abby is a danger to herself, the therapist must inform the appropriate authorities and arrange for inpatient therapy at an appropriate facility.Duty to warn is a significant responsibility for mental health counselors.Abby's therapist must not fail to intervene if she appears to be a danger to herself, or to others (Simone & Fulero, 2009).

Overall Therapeutic Goal

The overall therapeutic goal for Abby is to form a relationship with her therapist based on mutual respect wherein she can increase her self-awareness, explore her identity, redefine her life goals, and develop her personal strengths (Corey, 2009). Through this exploration, she can develop a new and a more positive outlook on life and herself, understand her personal psychological dynamics, and reorient her self-perspective.It will benefit Abby to discover the internalized emotions that prevent her from being happy and functioning with emotional stability.Overcoming her feelings of discouragement and inferiority created in the past will allow her to function (Corey, 2009).During therapy Abby will learn how to correct her maladapted idea of herself and learn to respect and accept herself (Corey, 2009).

The Therapeutic Process

Beginning with the Client

During the initial meeting, the therapist will gather as much information as possible on Abby's pastto make a comprehensive assessment of her life (Corey, 2009).The therapist will use a questionnaire wherein Abby can disclose her family information.This will help assess the "critical influences that have had a bearing on the role the client has assumed in the world" (Corey, 2009, p. 105).Early recollections will contribute to a more accurate and deep understanding of Abby (Corey, 2009).

Goals of Therapy

The post-assessment phase will continue to focus on building the client/therapist relationship and understanding and reviewing Abby's perceptions of her life and herself.Goals for her will include overcoming her discouragement with her current situation and her sense of inadequacy and inferiority.Additionally, therapy will help Abby gain a new perspective of her role in life as well as with her husband.Encouragement is central to the client/therapist relationship, and it is a "crucial aspect of human growth and development" (Watts & Pietrzak, 2000, p. 442).Therapy will encourage Abby's self-understanding and insight and will help her rely on her strengths as she works through her challenges.

Strategies and Techniques

Initially, it is important to listen attentively to Abby rather than focus on techniques, and make sure she is receiving the empathy and care she needs.To help the therapist develop an articulate understanding of Abby, he or she uses interviews to gain a deeper understanding of her psychological dynamics (Corey, 2009).From these interviews the therapist presents a summary of the information and provides an opportunity for Abby to view and discuss her life from a different perspective (Corey, 2009). The therapist will guess and hypothesize on the reasons for Abby's behavior, deepening her understanding of who she is, as well as why she is that way.